Role of Aminoglycosides and Fosfomycin in Enteric Fever: A Call for Clinical Trials

The escalating Antimicrobial Resistance (AMR) in enteric fever, particularly in South Asia, has compromised the efficacy of standard treatments. Recent data from Pakistan reveal high resistance rates to first-line agents, including third-generation cephalosporins and azithromycin, prompting the need for alternative therapies. This letter highlights the overlooked potential of aminoglycosides (amikacin and gentamicin) and fosfomycin, which have shown high in vitro sensitivity against Salmonella Typhi. Supported by regional studies and case reports, we advocate for the urgent initiation of clinical trials to evaluate the clinical efficacy and safety of these agents. Their inclusion in treatment protocols may offer a cost-effective solution to the growing burden of drug-resistant typhoid fever.